At a Glance

Why Get Tested?

To screen for or diagnose a gonorrhea infection

When to Get Tested?

For screening: may be recommended if you are sexually active, pregnant or considering pregnancy, or at increased risk for this sexually transmitted disease (STD) For diagnosis: when you have symptoms of this STD, such as pain during urination or bowel movements, anal discharge, itching, soreness, or bleeding, increased vaginal discharge or vaginal bleeding between menstrual periods (in females), or penile discharge or painful, swollen testicles (in males); when a newborn has conjunctivitis

Sample Required?

A swab of secretion or discharge from the infected area or a first-catch urine sample

Test Preparation Needed?

Tell your health care provider about use of antibiotics or, for women, douches or vaginal creams within 24 hours before testing vaginal samples, as they may affect test results. For a urine sample, you may be instructed to wait one to two hours after you last urinated before collecting a urine sample. Follow the instructions you are given.

The Test Sample

What is being tested?

The test is looking for presence of the bacterium Neisseria gonorrhoeae, which causes the sexually transmitted disease gonorrhea. The Centers for Disease Control and Prevention (CDC) estimates that more than 700,000 people in the U.S. get new gonorrheal infections each year, but only half of these infections get reported to the CDC. In the U.S., the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans.

Gonorrhea is generally transmitted through sexual contact (oral, vaginal, or anal) with an infected partner. An infected mother can pass the disease to her baby during childbirth. Symptoms in newborns include conjunctivitis and pneumonia, which usually develop 5 to 12 days after birth. Complications in infants include eye infections which, if left untreated, can cause blindness.

While many men with gonorrhea will experience symptoms, most women do not, or will mistake gonorrhea symptoms for a bladder or other vaginal infection. For men, symptoms usually appear within 2 to 5 days of infection but can take up to 30 days. Women who experience symptoms usually do so within 10 days of infection.

Gonorrhea can usually be treated with a course of antibiotics. If left untreated, gonorrhea can cause complications in men, women, and infants. In men, untreated gonorrhea infections may lead to:

About 1% of men or women with gonorrhea may develop Disseminated Gonococcal Infection (DGI), resulting from spread of gonorrhea infection to sites other than genitals. DGI symptoms include fever, multiple skin lesions, painful swelling of joints (gonococcal arthritis), infection of the inner lining of the heart, and inflammation of the membrane covering the brain and spinal cord (meningitis). Symptoms of DGI in infants include those associated with arthritis, meningitis and sepsis, a bacterial infection of the blood. DGI can be successfully treated using antibiotics similar to those used for treating uncomplicated gonorrhea.

However, treatment-resistant gonorrhea is a growing threat. Currently, CDC guidelines recommend dual therapy with a cephalosporin antibiotic (ceftriaxone is preferred) and either azithromycin or doxycycline to treat all uncomplicated gonococcal infections among adults and adolescents in the United States. A new strain of gonorrhea is resistant to cephalosporins. Cephalosporin resistance poses threats to people infected with treatment-resistant gonorrhea. There may be times that a person's symptoms do not resolve after treatment. The doctor may need to perform additional "tests for cure" and susceptibility testing may be indicated.

Greater use of newer non-culture-based laboratory technology such as NAAT and other molecular tests makes it difficult for laboratories to perform essential gonorrhea culture techniques required for antibiotic susceptibility testing. No reliable technology currently allows for antibiotic susceptibility testing from non-culture specimens.

How is the sample collected for testing?

Many different kinds of samples may be used for testing, but not all laboratories can test every kind of sample. A health practitioner may use a swab to collect a sample of secretion or discharge from the infected area such as the urethra, penis, anus, throat, cervix or vagina. Many doctors will take a sample from more than one body site to increase the likelihood of finding the bacteria. Sometimes a vaginal sample may be collected with a swab by the woman who is undergoing testing (self-collection). A first-catch urine sample is collected in a container provided by the health practitioner or laboratory.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

Tell your health care provider about use of antibiotics or, if you are a woman, douches or vaginal creams within 24 hours before testing vaginal samples, as they may affect test results. You may be instructed to wait one to two hours after you last urinated before collecting the urine sample. Follow any instructions you are given.

The Test

How is it used?

The gonorrhea test is used to:

Diagnose the cause of symptoms

Screen sexually active people

Document that a person has been sexually abused

A definitive diagnosis is important because symptoms of gonorrhea can resemble chlamydia clinically and the two disorders require different treatment. Since the disorders have similar symptoms, doctors often test for Neisseria gonorrhoeae and Chlamydia trachomatis simultaneously.

There are several methods available, but the preferred methods of testing for gonorrhea currently are molecular tests, including the nucleic acid amplification test (NAAT). NAAT allows testing of the widest variety of specimen types, including endocervical swabs, vaginal swabs, urethral swabs (men), and urine (from both men and women). The sensitivity of NAATs for the detection of N. gonorrhoeae is superior to culture.

The Centers for Disease Control and Prevention (CDC) recommends that victims of sexual assaults get NAAT testing for both C. trachomatis and N. gonorrhoeae, which are among the diseases most commonly transmitted in such cases, so that they can receive treatment if infected. However, molecular tests should not be used to verify cases with legal implications such as sexual assault. Until the legal system changes, only a positive culture result proving infection with gonorrhea is admissible in court.

In men, a quick method that may be used in a clinic or doctor's office is the gram stain, which allows the doctor to look at a sample from the urethra for the presence of the bacteria using a microscope. While this method can diagnose gonorrhea, it is not sufficient to rule out an infection in asymptomatic men. This method is not reliable for samples from women.

When is it ordered?

A health care provider may order a gonorrhea test if a person has symptoms, such as (for women) increased vaginal discharge, bleeding associated with vaginal intercourse, or burning/painful urination; or (for men) pus discharging from the penis, a burning sensation during urination, or proctitis (inflammation of the rectal or anal area). However, because many infected people do not have any symptoms, a number of organizations have published screening recommendations.

The U.S. Centers for Disease Control and Prevention (CDC), U.S. Preventive Services Task Force (USPSTF), the American Academy of Family of Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) recommend gonorrhea screening for sexually active women at increased risk. This may include women under the age of 25 and those with a new or multiple sex partners as well as other risk factors. The CDC and ACOG specifically recommend annual screening.

These organizations do not recommend routine screening for sexually active, heterosexual males. Health care providers may, however, use their judgment and consider risks, such as prevalence of these STDs in the community. The CDC does recommend that sexually active men who have sex with other men have gonorrhea screening at least annually.

For pregnant women, the CDC recommends screening at-risk women for gonorrhea during the first prenatal visit. Those diagnosed with gonorrhea during the first trimester should be retested within 3 to 6 months, preferably in the third trimester. (See Pregnancy & Prenatal Testing.)

Testing for both chlamydia and gonorrhea may be done when a newborn has symptoms of conjunctivitis, such as redness and swelling of the eye, and discharge.

What does the test result mean?

A positive test indicates an active infection that requires treatment with a course of antibiotics.

A negative test means only that there is no evidence of disease at the time of the test. It is important for those who are at increased risk of infection to have screening tests performed on a regular basis to check for possible exposure.

If you are infected, your sexual partner(s) should also be tested and treated as well.

Is there anything else I should know?

Molecular tests are only FDA-approved for use with urine samples or samples from genital sites such as the vagina and penis; they have not been FDA-approved for performance with ocular (eye), pharyngeal (throat), or rectal samples. Individual laboratories may perform molecular testing on these samples, but they are required to validate the methods themselves.

2. How can gonorrhea be prevented?

The most reliable ways to avoid infection with gonorrhea or any sexually transmitted disease are to abstain from oral, vaginal, and anal sex or to be in a long-term, mutually monogamous relationship with an uninfected partner. People who are sexually active should correctly and consistently use condoms to reduce the risk of infection with gonorrhea and other STDs.

Ask a Laboratory Scientist

Form temporarily unavailable

Due to a dramatic increase in the number of questions submitted to the volunteer laboratory scientists who respond to our users, we have had to limit the number of questions that can be submitted each day. Unfortunately, we have reached that limit today and are unable to accept your inquiry now. We understand that your questions are vital to your health and peace of mind, and recommend instead that you speak with your doctor or another healthcare professional. We apologize for this inconvenience.

This was not an easy step for us to take, as the volunteers on the response team are dedicated to the work they do and are often inspired by the help they can provide. We are actively seeking to expand our capability so that we can again accept and answer all user questions. We will accept and respond to the same limited number of questions tomorrow, but expect to resume the service, 24/7, as soon as possible.

Elsewhere On The Web

Article Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

United States Preventive Service Task Force. USPSTF Recommendations for STI Screening. Available online at http://www.uspreventiveservicestaskforce.org/uspstf08/methods/stinfections.htm through http://www.uspreventiveservicestaskforce.org. Last updated March 2008. Accessed July 2, 2012.

Centers for Disease Control and Prevention. Chlamydia and Gonorrhea — Two Most Commonly Reported Infectious Diseases in the United States. Available online at http://www.cdc.gov/Features/dsSTDData/ through http://www.cdc.gov. Last updated April 22, 2011. Accessed July 2, 2012.

American Social Health Association. Gonorrhea. Available online at http://www.ashastd.org/std-sti/gonorrhea.html through http://www.ashastd.org. Copyright 2012. Accessed July , 2012.

Centers for Disease Control and Prevention. Public Health Grand Rounds: The Growing Threat of Multidrug-Resistant Gonorrhea. Available online at http://www.cdc.gov/about/grand-rounds/archives/2012/May2012.htm through http://www.cdc.gov. Presented May 15, 2012. Accessed July 6, 2012.

Centers for Disease Control and Prevention. 2010 Treatment Guidelines, Special Populations. Available online at http://www.cdc.gov/std/treatment/2010/specialpops.htm#msm through http://www.cdc.gov. Accessed September 2012.

Proudly sponsored by ...

Learn more about ...

Get the Mobile App

Follow Us

This article was last reviewed on September 27, 2012. | This article was last modified on June 25, 2014.

The review date indicates when the article was last reviewed from beginning to end to ensure that it reflects the most current science. A review may not require any modifications to the article, so the two dates may not always agree.

The modified date indicates that one or more changes were made to the article. Such changes may or may not result from a full review of the article, so the two dates may not always agree.